NHS CONTINUING HEALTH CARE
FREQUENTLY ASKED QUESTIONS:
Q. What is NHS Continuing Health Care?
A. If the individual's primary need is health care, due to an ailment, ill-health or disability, the NHS must provide ongoing care free of charge
Q. Is where a person resides a factor in determining their entitlement to Continuing Health Care?
A. It does not matter where the person is; it could be in a Hospital, Nursing Home, Residential Home or indeed their own home. If their primary need is health care, the NHS must pay.
Q. My father was discharged from hospital to a Nursing Home and told he would have to pay towards his care. Is this right?
A. Before he was discharged an assessment should have been carried out by the hospital. You can ask to see a copy.
Q. An assessment was carried out on my father, but they said he did not meet the criteria for free care. What does this mean?
A. Health Authorities write their own criteria to see if people qualify for NHS funded Continuing Care. In our experience, they have often used this criteria to refuse NHS funding.
Q. Is there anything I can do if they turn him down for Continuing Care?
A. Yes there is. The criteria does not have the force of law. The Courts have already ruled that some of these criteria are not lawful.In 1999 the Court of Appeal ruled in the case of Coughlan that a local council can only provide health care if it is ancilliary to the provision of accomodation.
Q. The Health Authority said my father does not qualify for free care because his needs are not unpredictable, unstable or complex. What does this mean?
A. This is the usual Health Authority criteria, but it is simply not lawful. The law is quite clear: if the primary need is health care, the NHS should pay, even if someone's needs are predictable, stable and not complex.
Q. The Health Authority said I can go before an "Independent Review Panel" to resolve our dispute about funding. What is this panel?
A. First of all, it is not "independent". It is set up by the NHS, and its terms of reference are also laid down by the Local Health Authority. These panels can only advise and are told to apply the Local Health Authority's own guide lines.
Q. The Review Panel looking at my father's case has said that I can attend, but I am not allowed to have a Lawyer to represent me. Is this right?
A. Some of these issues are very complex and you certainly may need a Lawyer to represent you, in our view, this only shows how biased the system is against you. If you are refused legal representation take the matter up with your lawyer.
Q. Can I take my case to the Health Ombudsman?
A. Yes, you can. However, you will have had to have gone through the Local Health Authority's procedures first. This can take a long time, and the Ombudsman might also take several months to review your case as well.
Q. So if the Ombudsman finds in my favour, the Health Authority will pay?
A. Not necessarily. They can review the matter again and still decide that you do not qualify for NHS funding so you can find yourself back at square one.
Q. What happens if the NHS decides that my father is not eligible for Continuing Care funding?
A. If the NHS decides that your father is not eligible for funding, the Local Council would have to make the necessary arrangements for him to go into a Home. They could charge him for the care.
Q. Who pays for the care if my father has no pension, savings or home of his own?
A. The Local Council tax payer will have to fund his Residential Care.
Q. Does this mean that in reality the Local Council tax payer could end up funding care that they shouldn't be?
A. Remember what we said earlier. If someone's primary need is health care, the NHS must provide it. Local Councils can only provide very limited health care if it is "ancillary to the provision of accommodation". For example, someone is in a Residential Home, but may occasionally need a visit from a Chiropodist.
Q. My mother was in a Home up until three years ago when she died and was made to pay for her care. Can this case be looked at again?
A. Yes it can. The Health Ombudsman said that cases going back to 1997 should be reviewed, but at the very least you should be able to go back six years to look at cases even if someone has died in the meantime.
Q. This sounds very difficult and complicated. Can I get help with this matter?
A. Yes, you can. You can go to a Solicitor who has expertise in this matter and knows what they are talking about. They should give you at least free initial advice as to what to do with your case.
Q. Have other people been successful in getting money back?
A. Yes, many people have been successful in overturning the refusal of the Health Authorities to fund their care. Some people have had tens of thousands of pounds repaid to them for being wrongly charged in past years.
Q. Why haven't I heard much about this?
A. Because the Health Authorities try to keep it quiet. Usually, they settle before they are due to go to Court or legal proceedings are issued. This way, they can avoid publicity on the matter.
Q. How much would they have to pay a Nursing Home if they were funding it themselves?
A. At least £26,000 per year and above is currently the going rate for funding. This is why many people have a Charging Order put on their homes so that the value of the home is used to fund the care.
Q. Who should I contact for further information?
A. For more information about these Frequently Asked Questions contact Bleddyn Hancock, General Secretary of NACODS (Wales) on 02920470992 or mobile 07778979312. Email firstname.lastname@example.org